Low-effort HIV training in Spanish primary care: Long-term impact on testing and diagnosis

Recent improvements in the HIV care cascade have reduced HIV incidence in high- and middle-income countries, yet late HIV diagnosis remains a critical issue. This study examines the impact of a two-hour training session on HIV testing and diagnosis rates in primary care centers in Madrid, Spain.

In 2017, we conducted a non-mandatory, two-hour training session on updated HIV and HCV guidelines for primary care providers in 20 centers within the Ramón y Cajal Hospital area. We compared yearly HIV testing rates and late diagnosis rates in the five years before and after the intervention. We used data from Ramón y Cajal Hospital Microbiology Department's electronic records and the CoRIS cohort, including demographic and clinical information.

Of the 630 target primary care providers, 454 (72%) attended the sessions. HIV testing rates increased from 1780 to 2155 tests per 100,000 inhabitants (p<0.0001) post-intervention, with a stable rate of positive tests. Late diagnosis rates in our area decreased from 58.9% to 48.7%, while rates in the rest of Madrid and Spain increased (AOR 1.22, p<0.001). The intervention area showed a significant reduction in advanced HIV disease (AOR 0.66, p=0.095), contrasting with the upward trend in other regions.

A simple two-hour training session for primary care providers effectively increased HIV testing rates and reduced late diagnoses in our health area compared to national trends. Implementing similar strategies on a broader scale could help mitigate the rising rates of late HIV diagnosis and improve overall community health outcomes.